10 year anniversary

It's hard to imagine that 10 years ago, today, I was diagnosed with type 1 diabetes.  A rough estimate, over the past 10 years I've:

• Tested my blood sugar 55,000 times
• Performed about 1,000 pump infusion set insertions over the 5 years I was on a pump
• Taken 14,000 shots of insulin over the 5 years I've been on MDI
• Had about 110,000 units of short acting insulin and 40,000 units of long acting insulin
• Done close to 200,000 carb to insulin formulas during my daily routine

But those numbers can't come close to quantifying how this disease has made me a better man or the growth and success I've had over the past decade.  Over those same 10 years I've:

• Completed 2 Ironman triathlons and 7 half Ironmans
• Finished 2 Marathons
• Earned my MBA
• Grown to be a leader in the field of healthcare technology, now working on digital solutions in diabetes
• Started, most importantly, a beautiful family with an amazing, beautiful wife and the most incredible son the world has ever seen.

I truly don't believe any of the 5 remarkable bullet points would have been possible without the first 5 diabetic points.  I've said many times diabetes changed me for the better.  As I look back on the past 10 years I thank this disease for transforming me.  I thank this disease for making me look beyond myself, for making me appreciate every day and for challenging me to realize how much life has to offer.  

I've "rung the bolus" for the past decade and continue to have a fire to make the next 10 years with diabetes more impactful than the last.  This disease continues to send me on an amazing journey as I continue to give each day everything I have.

Getting back in gear

It's been a while; hello again (although I've said that a few too many times in the past dozen posts or so).  So I have to admit, I was burnt out.  When I first was diagnosed in 2007 I went after this disease hard.  Heck the only way I could prove to myself that I could live with this disease was through completing an Ironman and that level of focus took a toll.  It took a bunch of years, way too many workouts and an amazing wife for me to realize I'm living "with," not living "against," this disease.  That change in thought process let me step back and get my head back in the game.

I've decided to get back into triathlon, for the pure enjoyment I get from the sport.  I tried just cycling for a few years but am too old and too busy at work to train to the level I need to to be competitive.  The great thing about Triathlon is you are competing against yourself; you get out what you put in, there's no such thing as a bad race, just a slow one.  And it's become important for me to share my story again.

My last a1c was a flat 6!  But it was a struggle to get there; broken pumps, infusion sets ripping out, changes in diet and lifestyle.  I'm back on shots because frankly I don't trust pumps to deliver insulin, that might change, it might not.  Regardless my life again is about learning from all the experiences I have in controlling blood sugars and I want to document them somewhere.  I hope this is the start of my writing again, after a few years I feel like I once again have something worth sharing.  As I get back to consistent training I want to share my struggles, in the past all those who have read my stories inspired me to run that extra step or swim that extra stroke, I hope we can get there again.

Please Let Bluetooth Happen!

One of the less serious but more annoying frustrations I deal with as a Type 1 is the amount of crap I need to carry in my pockets.  Thankfully K likes her bags so I can unload my cache of diabetic paraphernalia to her from time to time but that leads to some serious angst when I have to test or if I forgot to take my testing supplies out of her bag when we return home from dinner.  So I've been incredibly excited by both Dexcom's patent filing and Medtronic's announcement at Health 2.0.

I love my Dexcom, although I somewhat agree that a CGM is a luxury device, it gives me the confidence I need to get through the day.  Seeing my glucose trends in real-time lets me make smarter decisions; like knowing if I need to exit a meeting to treat a low or run out of a movie to grab a coke. However, having to carry my cell phone, finger pricking stuff and CGM makes me sometimes feel like I need an extra large suitcase on wheels to bring everything around with me.

Having my CGM (or insulin pump controls for that matter) connect directly to my cell phone simply makes sense.  Phones have become the control center for everything we do electronically.  We can communicate with friends, book reservations, find a taxi or get directions all from our pockets.  Yet I can't look at a number that is already communicated to a separate hand held device?  Bluetooth is a pretty accurate technology and does not greatly impair battery life.  Plus I've never blindly trusted my CGM so I do not buy the worry that bluetooth may be less accurate than the current radio technology the sensor and transmitter uses.  The bluetooth direction will reduce one huge frustration I have in managing my disease and think it could open the door for some big improvements in managing the lifestyle side of Type 1.

Challenges Will Always Happen

Friday night I headed home after a long week at work excited to have my first weekend home in over 7 weeks.  K and I had a whirlwind of a summer with family obligations, vacation, sports travel and a bunch of other stuff.  This past weekend we were psyched to enjoy NYC and get in a bunch of couch time.  Friday night was relaxing as planned but the sh*t show of health issues began ominously on Saturday morning.

Since this was our first weekend home in quite some time I thought it would be great to cook K breakfast in bed on Saturday.  My awesome idea started by dropping 2 eggs directly onto the oven as I tried to flip another off our skillet and our coffee machine deciding it was a better idea to spray all over the counter than get into the carafe.  This was followed by yours truly essentially knocking himself out by banging my head on the bottom of a cupboard as I bent over to pick up a dropped water bottle.  All in a tough start to a Saturday!

Following my 1.5 hour trainer ride my blood sugar was a pesky 195; high for the amount of food I had taken in but figured my body was still just tired.  I had a kind of light lunch and was surprised my blood sugar had climbed to 285 after a mile walk.  This is when the real fun started.

Saturday evening K and I were scheduled to attend an event for Marjorie's Fund, a non-profit lead by my endo, Dr. B, that focuses on helping the under privileged and developing countries get the medical supplies they need to manage type 1.  Both Dr. B and Lauren, my sports nutritionist, were on the agenda to speak so I was actually looking forward to attending.  An hour into the event my blood sugar was still at 305 (the third straight hour of being in the 300s), so I found Dr. B and let him know I wouldn't be able to stay for the talking portion of the evening; this also meant I had to cancel K and my dinner reservations.

Once home I changed to a new vial of humalog, got a new insertion set and commenced the blood sugar management games.  My rage bolus of 4 units of humalog added to the five units I already had in made for a super interesting 7 hours.  For dinner I had an english muffin with peanut butter and an hour later my blood sugar had already dropped 175 points.  I added a clif mojo bar to my stomach and had hoped my bs would stabalize around 120.  I was woken 3 times that night with blood sugars in the 40s - 50s and woke up Sunday with a bs of 58.  It seemed the highs were over so I was excited for a Sunday of exercise and football.

Excitedly, K and I headed up to Central Park for a run mid-morning Sunday.  Most of my exercise over the past year has been focused solely on cycling.  I've run in a pinch or when my legs needed a break but 7 - 8 miles is about the longest run I've had in the past year.  Sunday I decided to get after it with a full loop of CP plus the carriage loop (another 2 miles) so 8.5 miles in total on rolling hills.  I completed the run at close to an 8 minute pace (somehow) with an amazingly stable blood sugar.  An hour later the fun began.

My blood sugar stayed close to 200 after my run (weird for me) and then my stomach was put into a vice grip.  For the next 6 hours I was laid up on our living room couch in the fetal position trying to keep my eyes open and my butt out of the bathroom.  The combination of the highs the night before and my sweat from the run must have had me totally dehydrated.  That led to some major major stomach cramps and a bad case of the runners trots.

Moral of the story, each day brings a new challenge and sometimes you just gotta roll with the best laid plans.  Plus, I owe my wife one heck of a night out with all she put up with this weekend as a type 3.

Biking to work in NYC - $@#!!!!

During my MBA summer internship 5 years ago I got into the habit of biking into work.  I find getting to work with my legs as the engine liberating and relaxing.  Plus starting the day with a 3 - 5 mile easy bike ride tends to stabilize my blood sugars.  That habit continued through my time in San Francisco and for the past 2.5 years in NY.  To this day I find riding a folding bike in NYC the single best form of transportation this city has to offer (my Cervelo is saved for real riding).

But the liberating feeling I have found through biking into work is starting to get replaced by rage.  There have been several news articles over the past few months discussing the hypocrisy of driver v cyclist laws, including this excellent piece from the NY Times.  However, I still find riding down the middle of 5th avenue during rush hour traffic "safer" than riding in NYC bike lanes.

Both our former Mayor Bloomberg and current Mayor DeBlasso have made instituting bike lanes across the city a big priority and they deserve huge kudos for that.  Lacking, however, is the basic education of pedestrians that bike lanes are not an extension of the sidewalk and demand the same respect as the regular part of the road.

Today I hit my boiling point.  For three consecutive streets I had to tell 3 people to get out of the middle of the bike lane.  The first two were mid 20s women, texting on their cell phones, head down, walking and stopping directly in the middle of the bike lane while the "don't walk" symbol was in the cross walk.  The third was a middle aged d*ck who starred at me as he lit his cigarette in the middle of the bike lane smack in the center between 9th and 8th street who had the audacity to tell me to "shut up," when I said, "dude a little heads up here."  A little over a month ago I was also t-boned by a 10 or 11 year old girl who decided it was a good idea to sprint from between cars directly into my front wheel, I told the Mother she was lucky I wasn't a car.

NYers consider themselves the smartest people on the planet, I should know I'm one of them.  So I find it impossible to believe that NYers fail to comprehend that this huge neon green painted lane on the street is not, in fact, an extension of the sidewalk.  Biking to work shouldn't be like navigating a Bosnian land mine field, it should be a great experience that has the same protection and rights as driving to work.  Alot needs to be done to educate pedestrians otherwise there is going to be a civil war in the bike lanes of NY with a whole bunch of charging rhinos hitting into people on cell phones.

Infusion Set Woes

Bruising, blood squirts, scar tissue and funky looking sites are some of the things a diabetic has to look forward to when pumping.  Those fun events combined with the Animas infusion sets not working for me had me switch to shots for about a year.  I loved having a break from my "tail" but at the end of the day I have tighter control with a pump and a pump gives me much more flexibility for working out.

However, since going back on a pump about 6 months ago I've been dealing with a seriously viscous infusion set monster.  Once again I am a happy Minimed pumper using the silhouette infusion set.  This time around 1 in 4 infusion sets are attacking my rear end.

Not sure what I'm doing wrong this time but I've ripped infusion sets out after inserting them (ouch), have had some serious bruising, and on more than one occasion have had my wife chasing me around the apartment with a towel as I didn't realize blood was "gushing" down my leg.  She is starting to realize having white sheets with a type 1 hubby may not be the best idea in the world. 

I know I have buns of steel but it's time my caboose and the infusion sets start getting along...

It Takes 2

Well it's been a while that's for sure!  Since the last time I blogged I've gotten married, been promoted a few times, became a two-time Uncle and have had more diabetic lessons than I can remember.  I stepped away from blogging for a while so I could focus on handling my disease while my life was totally changing.

I learned that diabetes is a heck of alot easier to manage when you make 100% of the decisions for yourself. But when a person starts thinking as two and the other's happiness is even more important than your own blood sugar management becomes harder. K has always understood what I struggle with but she had to get up the same learning curve we all did when first diagnosed: what foods affect my blood sugars when, how to make time for cooking each meal, how to avoid unprocessed foods and how to help me make smart choices at each meal.  As we struggled up the learning curve my A1c and weight bounced around, my highest A1c was 7.2 (which had alot to do with the Animas infusion sets not working for me) and my weight at times crested 200 lbs.  But now she is a fully certified type 3 and understands how each piece of food will impact my blood sugar and fully supports why I'm obsessed with getting in hours of exercise.

With K's help my A1c was a shockingly low 6!  And my weight is now back under 190.  In her own subtle way she has taken over the grocery shopping, gotten me to refocus my diet and is making sure we eat out a ton less.  She lets me bring my bike on vacation and does whatever she can to help me fit in a long bike ride or run if there's going to be a feast that night.

Without her support there is no way I could have reached the lowest A1c I've had since I was still producing some insulin.  I once thought that I could fight this disease head on, that each day was about staring my blood sugar down and out working the problem.  It's way more of a dance than that; I can't do an Ironman everyday and I can't live my life on an organic farm.  It took a few years but K has taught me how to achieve amazing results while being less intense on how to get there.  No way could I have gotten to an A1c of 6 without her love and support.